Quashing dissent around the world.

 I’ve pinched the title of this post from a chapter heading in Professor Richard Feinman’s soon to be released 2^nd edition of his fabulous book, retitled “Nutrition in Crisis”.

 In this chapter he discusses the cases of five low carb advocates who were reported by dietitians to authorities. The ready-for-printing manuscript I read a few weeks ago reported positive outcomes for three of the cases but this has changed for the better since then. Hopefully a last minute adjustment can be made before going to print to include the wonderful news that the original decision in Gary Fettke’s case has been repealed. The Australian National Health Ombudsman independently reviewed the original ruling by AHPRA and found three issues with the AHPRA process. The case was referred back to the AHPRA Medical Board for an independent review, which resulted in the repeal of the previous decision in its entirety. Gary was cleared of any breach of good medical practice and the Board apologised to him.

This takes the number of positive outcomes to four out of five. The decision taken by the DAA to deregister me after its investigation of whether my recommendation of low carb diets for diabetes management was evidence based remains the only negative finding.

Unfortunately I have no avenue of independent review of the DAA’s decision, as it is a self-regulated organisation and has no reporting body to which it is accountable. Neither the Federal Health Minister, Ombudsman or COAG have jurisdiction over the DAA. Even a request to the DAA board members to correct what I consider are very clear factual errors on the DAA website about my case was responded to negatively.

That will be covered in another blog but for now, the good news decisions from around the world. I hope mine can be added to them soon.

Excerpts from chapter 19 in “Nutrition in Crisis” by Richard Feinman.

Quashing Dissent Around the World

“Coincidentally, it was in Sweden that the medical establishment revealed its resistance to criticism and to new ideas. Dr. Annika Dahlqvist lives in Njurunda, Sundsvall. She described, on her blog, how she discovered that a low-carbohydrate diet would help in her own battle with obesity and various health problems that included enteritis (irritable bowel syndrome or IBS), gastritis, fibromyalgia, chronic fatigue syndrome, insomnia and snoring. Recommending low‑carbohydrate diets for her patients and publicly advertising her ideas drew a certain amount of media attention, leading to a run-in with the authorities. In November 2006 she lost her job at Njurunda Medical Center. Ultimately exonerated in January 2008, the National Board of medicine found that a low‑carbohydrate diet was “consistent with good clinical practice.” This was the likely prelude to the announcement in 2013 that the Swedish Council on Health Technology Assessment, which is charged with assessing national health care treatment, endorsed low‑carbohydrate diets for weight loss. While their statements were far from enthusiastic, it was one of a number of events that indicated the fall of the low‑fat paradigm and the no-holds-barred backlash of nutritional medicine.

Stateside, a North Carolina blogger named Steve Cooksey was enjoined from recommending a low-carbohydrate diet for diabetes by the North Carolina Board of Dietetics/Nutrition. After a near-death experience from his own diabetes, and after experiencing the benefits of carbohydrate restriction, he felt it might be good to share the information with others, with due disclaimers about not offering medical advice. That was too much for the professional nutritionists who somehow have gotten the state legislature to designate them as sole purveyors of nutritional advice. Enlisting the aid of the Institute for Justice, Cooksey won a First Amendment lawsuit and the North Carolina Board realized that it could not tell American citizens what they could and could not say. The Board changed their guidelines, but the fury of a nutritionist spurned is great—and even worse down under.

The Dietitians Association of Australia (DAA) registers dietitians and essentially controls whether they can do their jobs in hospitals, universities or private practice. In 2015, the DAA expelled Jennifer Elliott, a dietitian with thirty years’ experience and a highly-regarded book for patients. She had also published a peer-reviewed critique of the diet-heart hypothesis, which likely contributed to the DAA action. The complaint from a DAA-registered dietitian was that Elliott’s recommendation of LCDs for her patients with type 2 diabetes was not “evidence-based.” The DAA upheld the complaint. In my personal communication with Claire Hewat, head of the DAA, however, she claimed that the cause of dismissal had not been the recommendations of LCD but something else that could not be revealed because it was confidential. The power of LCD diets to provoke hostile behavior remains fascinating if incomprehensible. In a blog post on the subject, I made an analogy to the Protestant Reformation, although unlike Luther, Jennifer Elliott was not particularly rebellious and was not trying to reform anything except her patients’ dietary habits. The DAA functions, after all, as a professional dietitians’ organization and should, as in Macbeth, against the murder shut the door, not bear the knife itself. There was some press coverage but little public awareness or professional outcry over the lack of natural justice and common decency.

The Tim Noakes Case. 

“… it is troublesome to hear that Tim is being attacked so strongly for what seems to be a trivial matter, when there are plenty of real problems in health care and our world more broadly.,,,       —– Walter Willett (personal communication)        

Most bizarre for its virulence remains the determination with which the Health Professionals Council of South Africa (HPSCA) tried to keep control by attacking Tim Noakes. A retired physician and widely-admired sports expert, and only a relatively recent spokesman for carbohydrate restriction , Noakes answered a comment on Twitter that suggested a newborn could be weaned to a low-carbohydrate diet, not particularly different from the recommendations of Australian authorities. Yes, this is about a single Tweet, which wasn’t even taken into account by the individual who’d asked the question in first place. A nutritionist was insulted by the affair and brought the case to the HPSCA. The question become whether Noakes’ tweet constituted medical advice—the primary affirmative argument being that because he was a medical doctor, anything Noakes said could be considered advice. This is just as ridiculous as the folk myth that a black belt in karate has to register his hands at local police stations as lethal weapons.

The HPSCA came down hard on Noakes but, after two years of trial, he was exonerated. The HPCSA’s own committee found that no harm derived from the tweet, and that his advice was “evidence-based” and within normal standards. HPSCA was able to establish a warning for other medical professionals, since as Noakes explained: “It’s been very, very demanding on us and on our lives and financially it’s been huge. Noakes asked, further, “Did they ever consider the consequences for my wife and myself and our family?” Indicating that it did not, (or perhaps, that it did — motives are unknown) —the HPSCA immediately appealed the decision of their own committee. While the decision of the new body was supposed to be produced with all deliberate speed, presumably innate pettiness caused them to drag it out for months. Noakes was finally exonerated. Besides a person of stature in Sports Medicine he is a charming, friendly person — I met him at a landmark conference at Ohio State University just as the final edits on this book were being prepared.

The most bizarre case, also in Australia, fell upon Dr. Gary Fettke, an orthopedic surgeon. A letter dated November 1, 2016 from AHPRA (Australian Health Practitioner Regulation Agency) stated:

“There is nothing associated with your medical training or education that makes you an expert or authority in the field of nutrition, diabetes or cancer.”

The training of any physician in nutrition is, in my view, problematic, but it has been pointed out that Fettke received the same training as other doctors. The letter continued:

“Even if, in the future, your views on the benefits of the LCHF lifestyle become the accepted best medical practice, this does not change the fundamental fact that you are not suitably trained or educated as a medical practitioner to be providing advice or recommendations on this topic as a medical practitioner.”

In short, even if they recognize the truth, they will not defend his right to say it. Many have pointed out that Dr. Fettke is in fact trained to remove the limbs of those whose diabetes has reached a critical point, despite the AHPRA’s attempts to diminish his credentials. This lack of due process and common decency speaks to the need for some kind of regulation. The lack of publicity in traditional media has kept the issue relatively invisible, but beyond that, it is clear why your health provider might not want to buck the system. It would be ugly if such a serious ethical problem came to light. Again, you may have to be your own health provider.”

Update on Gary’s case by Marika Sboros

http://foodmed.net/2018/09/fettke-ahpra-drops-charges-apologises

Possible next blog: A glimmer of hope?